Presidential candidate Mitt Romney is no stranger to health information technology advocacy. As governor of Massachusetts, he helped spur initiatives such as the $50 million nonprofit Massachusetts eHealth Collaborative, for instance, and he signed a 2003 bill meant to enable Bay State providers to more widely adopt e-prescribing.

But some experts say Romney’s Republican platform, promoting limited federal government and increased fiscal autonomy to the states could very well put federally funded health IT initiatives at risk.

Ed Daniels, consultant for health IT firm Point-of-Care Partners, wrote that, when it comes to health IT, “Romney is likely to be more of a cheerleader than a funder.”

He surmised that if Romney were elected, eventually, “Government incentive payments for EHR adoption likely will be dropped from future budgets.”

Romney has repeatedly and unabashedly stated that if he were elected, his first act in office would be to eliminate the Patient Protection and Affordable Care Act (ACA).

During the third presidential debate Oct. 22, Romney, when speaking of balancing the budget, said, “[The] number one I get rid of is Obamacare. There are a number of things that sound good but, frankly, we just can't afford them. And that one doesn't sound good, and it's not affordable, so I get rid of that one from day one.”

But the PPACA, of course, has many defenders.

After the Supreme Court’s landmark June 28 decision to uphold the law, Dave Roberts, vice president of government relations at HIMSS, said, “Consumers are going to be demanding ways to access their health information, and this will just be the tip of the iceberg on the innovations we’re going to see, now that this issue has been decided.”

The PPACA contains provisions to “improve the quality of healthcare by increasing quality data collected by health IT, creating new programs that involve health IT, and giving payments to existing entities for the use and improvement of health IT." It also has provisions related to setting new operating rules and standards that will directly or indirectly control the use and innovation of health IT and increasing the size of the health IT workforce across different sectors.

Romney has also established himself as a fierce opponent of Obama’s American Recovery and Reinvestment Act (ARRA) of 2009. That position may appeal to the GOP’s core constituents, but even some opponents of ARRA as a whole have conceded that Obama got some things right.

“I can report that there is one part of the president’s stimulus plan that is working. Really working,” wrote business and technology columnist Gene Marks in a July Forbes piece. The part of the law Marks supports happens to be the some $20 billion allocated for health IT adoption. "Slowly but surely,” he wrote, “It’s working.”

If Romney were elected in November, Stephen Beck, CMIO of Catholic Health Partners, says providers wouldn’t see a significant change in health IT policy – meaningful use in particular. “I contend that meaningful use won’t change because that’s law. There’s money that’s allocated for it,” Beck told Healthcare IT News. “I think even with a change in leadership at the country’s presidential level, there would still be a heavy focus on healthcare IT.”

Beck reflected back to 2002, when former President George W. Bush, during his state of the union address, coined the phrase "electronic health record" (EHR). “[Health IT] has been equally noted on the Republican side as well as the Democratic side, so I’m really not concerned about that,” he said.

Deven McGraw, director of the Health Privacy Project at the bipartisan Center for Democracy and Technology, however, argues that it could go either way if Romney were elected.

“Some folks were worried that, with the economic downturn and the need to address the deficit, that the dollars authorized by Congress for electronic health records might have a target on their back because they have an extended payout,” McGraw told Healthcare IT News. “There is money that’s promised but not yet spent, which makes it a very attractive target for a cut because nobody has those dollars yet."

As of September, $7.7 billion of that meaningful use money has been paid out to providers. As National Coordinator for Health IT Farzad Mostashari, MD, told the audience at a September HIMSS event: “Whoever qualifies, gets paid; there's no hard cap."

Government officials have pegged high estimates of EHR incentive payments at possibly exceeding $27 billion, leaving a potential $19.3 billion sitting and waiting for the providers’ race to attest.

McGraw remains hopeful the money won’t be taken back if Romney is elected – for two reasons. The first is that the benefits of EHRs are generally widely accepted by Republicans and Democrats alike. The second is that providers have already paid big money to update and implement their EHR systems.

“A whole lot of healthcare providers across the country have already made investments in anticipation that they will be reimbursed by the federal government,” she said. “It would be hard to take it back.”

But Beck points to other pressing concerns.

“I think the biggest concern that providers have is unfunded mandates,” he said. “ICD-10 is a great example. It’s something that’s an expectation; you need to do it to get paid, but putting it into practice for large organizations like ours … is a very expensive proposition.”

Most observers agree some health IT policies and initiatives will be revised under a Romney presidency.

How, to what extent, and whether those changes are for the better or for the worse? Only time will tell.